2011-2012 DSPP Program Year Introduction Impasse in Psychotherapy and Psychoanalysis Freud (1915) described the curious nature by which the unconscious of one person can, “react upon that of another” without the engagement of conscious awareness. This year we will examine the ways in which patient and therapist often unconsciously “react upon” one another in the co-creation of resistance and impasse in the therapeutic process. Particular emphasis will be given to the therapist’s contributions to impasse in the work with patients. We will begin the year with our Fall Workshop and distinguished psychoanalyst Judy Kantrowitz, who has written extensively on the subject of impasse. Kantrowitz (1993) states impasses arise “when a patient sees the analyst or therapist as having confirmed a preexisting belief that is central to, and possibly the basis of, the patient’s primary conflict.” Perhaps the term impasse is most often linked with instances of clear stalemate or rupture in the treatment, which may be relatively brief and resolvable, or which may lead to failure and termination of the treatment. There are also more subtle examples of impasse which occur outside of our awareness. In these instances, it may seem that the therapy is progressing when in fact little to no progress is occurring. Often the therapist/analyst colludes with the patient in developing and sustaining the roadblock. Judy Kantrowitz (1993) emphasizes that from the perspective of the therapist, impasse may occur when “…he or she is unable to understand what the patient is trying to communicate. Such a failure of understanding may be due to a limitation in theoretical or clinical knowledge of technique. A third possibility is that the failure stems from some psychological difficulty which resonates with the patient’s problems causing a transference-countertransference bind.” Jody Davies (2004) demonstrates that painful moments of impasse may simultaneously be experienced as opportunities for “profound mutuality and engagement”. Furthermore, she examines the difficulties of tolerating and working through intense, negative countertransference reactions, and the ways that failing to do so can interfere with progression of the therapy. Davies (2004) explores “how the evocation of intensely shame-riddled bad self representations in both the patient and the analyst can perpetuate a need to provoke, find, and sustain the badness clearly in the psychic domain of the other, blocking entry into certain necessary therapeutic enactments that may therefore fail to occur (p. 711).” Throughout the year, the topic of impasse will be explored from multiple perspectives. We will strive to understand how we manage these roadblocks when they occur, as well as the consequences if we fail to do so. We will examine impasse in the work with adults with sexual disturbances, adolescents, children and families in the context of adoption, those with severe characterological dysfunction, and within the treatment team and milieu of an inpatient program. We will conclude our year with our Spring Workshop and distinguished psychoanalyst and author, Jane Hall, LCSW, who will seek to reframe our views of impasse as moments of profound opportunity within the therapeutic relationship. DSPP President – Noelle McDonald, Ph.D. 2011-2012 PROGRAM YEAR Impasse in Psychotherapy and Psychoanalysis   September 17, 2011 Fall Workshop: Judy Kantrowitz, Ph.D. Obstacles to Love Saturday 8:30 to 4:00pm *Scottish Rite Hospital* Training and Supervising Psychoanalyst, Faculty, Boston Psychoanalytic Society and Institute; Associate Clinical Professor, Harvard Medical School Dr. Kantrowitz will focus on two different characterological patterns that interfere with the development and maintenance of intimacy. When affect intensity is managed by either freezing or flooding, the relationship to others is adversely affected. How the analyst understands and reacts to these ways of engaging will depend on his or her own characterological ways of dealing with affect and the underlying conflicts. Two clinical illustrations will be provided. Case Presentation: Alison Ligocki, Ph.D Kantrowitz, J. L. (1997). A different view of the therapeutic process: the impact of the patient on the analyst. Journal of the American Psychoanalytic Association, 45 (1), 127-153. Kantrowitz, J. L. (1999). Pathways to self-knowledge: self-analysis, mutual supervision, and other shared communications. International Journal of Psychoanalysis, 80, 111-132. Kantrowitz, J. L. (1999). The role of the preconscious in psychoanalysis. Journal of the American Psychoanalytic Association, 47, 65-89. October 19, 2011 Countertransference and Therapeutic Engagement: Living Through the Feelings that We Must Bear Wednesday 7 – 9pm Fred Griffin, M.D.   A crucial dimension of psychoanalytic therapy involves generating and sustaining a kind of empathic engagement that allows psychotherapists to explore in the transference-countertransference – at an affective level – what truly goes on within the internal object and interpersonal worlds of the patient. This requires that we bear what are often very painful emotional states long enough to reflect upon the meanings that are being communicated by them. Beyond the sheer emotional intensity of this process, difficulties may arise when we therapists must “take in” aspects of a patient that are perilously close to disowned parts of ourselves and which we must disavow and/or vigorously expel in order to maintain our own psychic equilibrium. November 16, 2011 Stop in the Name of Love: Impasses in Our Work with the Sexually Troubled Wednesday 7 – 9pm Gerald Melchiode, M.D.   Impasses are quite common in the treatment of patients with sexual problems. Why is this so? Is there something inherent in the nature of the sexual drive and sexual development? Could it be that our counter transferences are so much more difficult visa vis our patients’ sexual longings and behaviors? You are warmly welcomed to join me in a discussion of a topic of which little is written. Freud, S. (1937). Analysis Terminable and Interminable. In The Standard Edition of the Complete Psychological Works of Sigmund Freud, Volume XXIII (1937-1939): Moses and Monotheism, An Outline of Psychoanalysis and Other Works, 209-254. January 18, 2012 Impasse with an Adolescent Patient: Preserving the Relationship While Confronting Resistance Wednesday 7-9pm Skye Moffitt, Ph.D.   Skye Moffitt will present a case involving the complex treatment of an adolescent and the subsequent family work. She will explore different points in the treatment where an impasse affected the work. She will describe her own reactions to the various resistances that arose within the adolescent and the family. Hall, J. (2004). Transference: Its Ubiquity and Utility. In Roadblocks on the Journey of Psychotherapy, New York: Jason Aronson, 9-42. Perl, E. (2008). Repetition as a Path to a New Experience. In Psychotherapy with Adolescent Girls and Young Women: Fostering Autonomy through Attachment. New York: Guilford February 8, 2012 Growing Nowhere Fast: Ambivalence, Impasse and Lullaby Songs Wednesday 7-9pm Carla Pulliam, Ph.D. and Mark Pulliam   In November 2009, Mark and Carla Pulliam brought home a 2 1/2 year-old girl from the foster care system. Six months later, the Pulliams and their then 7- and 4-year-old biological children adopted this little girl. The staff psychologist at their adoption agency offered the poignant advice that the most important path to healing for children from foster care derives from residing with a permanent family that is willing to change as a result of what the child brings to it. During their talk, the Pulliams will incorporate literature on maternal ambivalence and the particular attachment-related struggles of children adopted from foster care and describe their family’s process of changing to integrate its newest member. Brinich, P.M. (1995). Psychoanalytic Perspectives on Adoption and Ambivalence. Psychoanalytic Psychology, 12, 181-199 Lanyado, M. (2003). The Emotional Tasks of Moving from Fostering to Adoption: Transitions, Attachment, Separation and Loss. Clinical Child Psychology and Psychiatry, 8 (3), 337-349. March 21, 2012 When Losing your Way Becomes the Treatment: Impasses and Potential Therapeutic Progress Wednesday 7 – 9pm Michael Groat, PhD; Assistant Professor of Psychiatry and Behavioral Sciences, Baylor College of Medicine; Director, Professionals in Crisis Program, The Menninger Clinic   Clinicians routinely work with difficult to treat patients where gains are made slowly, or worse, apparent impasses are reached. Feelings of frustration with the patient, self-blame, guilt, shame and a sense of therapeutic failure can make it difficult to find a way forward. Such scenarios can occur with individual practitioners, as well as with treatment teams in clinics, outpatient programs, or inpatient units. Examining one such experience from a long-term inpatient unit, this presentation and discussion will examine the factors that helped resolve an apparent impasse in the treatment of a man with prominent narcissistic and masochistic personality dynamics. Having powerfully enacted a repetition of his core conflicts with fellow patients and the treatment team, the inpatient unit staff realized that it was feeling held hostage by the patient’s incessant demands and had lost its effectiveness. How the team found its way again, and the difficult process involved, will be the subject of discussion. Ness, D. E., & Groat, M. (2011). How can we help masochistic inpatients not to sabotage psychiatric treatment before it even starts? Journal of Psychiatric Practice, 17 (2), 124-128. April 21, 2012   Saturday 8:30 - 4:00pm Spring Workshop*: Jane Hall, LCSW Dancing in the Dark: Intuition as a Guiding Light Training and Supervising Psychoanalyst at the New York Freudian Society; founder of The New York School for Psychotherapy   Labels such as negative therapeutic reaction or impasse (a deadlock with no anticipated progress) can box us in. Today I invite us to explore what makes the therapist resort to these labels. Using case material I will revisit the repetition compulsion and the attachment to abuse that often exhaust the dyad. My premise is that benevolent curiosity, hopefulness, caritas, and patience are what keep us going. I will remind us that change, no matter how longed for, means loss: loss of early objects, reliable (though often crippling) defenses, and even one's sense of self. What often seem like impasses can be seen as calls for help to face powerful fears of separation. Although our work seeks to cast light we must also be comfortable dancing in the dark. Case Presentation: To Be Announced Levine, H. (2010). Creating analysts; creating analytic patients, International Journal of Psychoanalysis, 91, 1385-1404. *The Spring Workshop with Jane Hall, LCSW is co-sponsored by DSPP, the Dallas Psychoanalytic Center, and the Dallas Society for Psychoanalytic Social Work. 6 CMEs and CEUs provided for Fall and Spring Workshops, 3 CEU’s for Ethics Workshop, 1.5 CEUs for Wednesday meetings. WORKSHOP AND MONTHLY MEETING LOCATIONS The Fall Workshop will be held at Scottish Rite Hospital for Children auditorium, 2222 Welborn Street, Dallas, TX 75219. The Spring Workshop will be held at UT Southwestern Medical Center, Department of Psychiatry, 8th floor, room NC8.212. Maps for all program sites as well as updates will be available on the DSPP website at www.dspp.com. All DSPP Wednesday evening monthly mini-workshops will be held at Pecan Creek Office Park, 8340 Meadow Road in Dallas. The Pecan Creek Office Park is near the intersection of Walnut Hill Lane and Greenville Avenue across from Presbyterian Hospital. Drinks and snacks will be served at 7pm, presentations begin at 7:30pm. The mini-workshops are free to members and students. Non-member professionals may attend for $10 per workshop, payable on site. The fee includes CEUs, drinks & snacks. To make an online donation to DSPP ARTS please click here.

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